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HomeMy WebLinkAbout125410 Department ofrle Revenue Washington State REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt PLEASE TYPE OR PRINT CHAPTER 82.45 RCW—CHAPTER 458-61A WAC when stamped by cashier. THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FULLY COMPLETED (See back of last page for instructions) 0 Check box if partial sale of property If multiple owners,list percentage of ownership next to name. IIII Name Amy Choi and Sun Y Choi, husband and wife Name IM Hotel,LLC,a Washington limited liability company c4 0 ca Mailing Address 330 Benedict St Mailing Address 330 Benedict St c City/State/Zip Port Townsend, WA 98368 m g City /State/Zip Port Townsend,WA 98368 __ d (6- 17(,\ Phone No.(including area code) Phone No.(including area code) © Send all property tax correspondence to: Same as Buyer/Grantee List all real and personal property tax parcel account List assessed value(s) numbers—check box if personal property Name 957616801 4, 2_t ^CM Mailing Address City/State/Zip n Phone No.(including area code) n Street address of property: 330 Benedict St.Port Townsend.WA 98368 This property is located in Port Townsend 0 Check box if any of the listed parcels are being segregated from another parcel,are part of a boundary line adjustment or parcels being merged. Legal description of property(if more space is needed,you may attach a separate sheet to each page of the affidavit) Lots 1 through 8 inclusive,Block 168 Hasting's Second Addition to the City of Port Townsend,as per plat recorded in Volume 1 of Plats, page 29,records of Jefferson County,Washington. TOGETHER WITH that portion of vacated Morrison Street,vacated under Ordinance No. 1672,of the City of Port Townsend,that would attach by operation of law Situate in the County of Jefferson,State of Washington. Select Land Use Code(s): List all personal property(tangible and intangible)included in selling 16-Hotels/motels price. enter any additional codes: (See back of last page for instructions) YES NO Was the seller receiving a property tax exemption or deferral under ❑ 0 chapters 84.36,84.37,or 84.38 RCW(nonprofit organization,senior citizen,or disabled person,homeowner with limited income)? YES NO If claiming an exemption, list WAC number and reason for exemption: Is this property designated as forest land per chapter 84.33 RCW? 0 0 WAC No. (Section/Subsection) Is this property classified as current use(open space,faun and 0 0Reason for exemption agricultural,or timber)land per chapter 8434? p Is this property receiving special valuation as historical property 0 per chapter 84.26 RCW? If any answers are yes,complete as instructed below. Type of Document Statutory Warranty Deed (1)NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) NEW OWNER(S):To continue the current designation as forest land or Date of Document 5/17/16 classification as current use(open space,farm and agriculture,or timber)land, 5,435,000.00 you must sign on(3)below.The county assessor must then determine if the Gross Selling Price $ land transferred continues to qualify and will indicate by signing below.If the *Personal Property(deduct) $ land no longer qualifies or you do not wish to continue the designation or Exemption Claimed (deduct) $ classification,it will be removed and the compensating or additional taxes will be due and payable by the seller or transferor at the time of sale.(RCW Taxable Selling Price $ 5,435,000.00 84.33.140 or RCW 84.34.108).Prior to signing(3)below,you may contact Excise Tax : State $ 69,568.00 your local county assessor for more information. 0.0050 Local $ 27,175.00 This land aloes 0 does not qualify for continuance. *Delinquent Interest: State $ Local $ DEPUTY ASSESSOR DATE *Delinquent Penalty $ (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) 96,743.00 NEW OWNER(S):To continue special valuation as historic property, Subtotal $ sign(3)below.If the new owner(s)does not wish to continue,all *State Technology Fee $ 5.00 additional tax calculated pursuant to chapter 84.26 RCW,shall be due and payable by the seller or transferor at the time of sale. *Affidavit Processing Fee $ 0.00 (3) OWNER(S)SIGNATURE Total Due $ 96,748.00 PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX *SEE INSTRUCTIONS I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. Signature of Signature of Grantor or Grantor's AgentGrantee or Grantee's Agent Name(print) Sun Y.Choi Name(print) Young Soo Im,Member Date&city of signing: May 17,2016;Federal Way,WA Date&city of signing: May 17,2016;Federal Way,WA Perjury:Perjury is a class C felony which is punishable by imprisonment in the state correctional institution for a maximum term of not more than five years,or by a fine in an amount fixed by the court of not more than five thousand dollars($5,000.00),or by both imprisonment and fine(RCW 9A.20.021(1)(C)). DEPT.OF REVENU 75551 125+1 *5/1;3/2016 9i:,748.0O4: ► I l2 L.1 (O 'i